Concordance of a Web-based Lung Cancer Risk Self-Assessment Tool With Nursing Risk Assessment

The Alberta Lung Cancer Screening Program implemented a web-based risk self-assessment tool using the Prostate, Lung, Colorectal, Ovarian Model 2012 (PLCOm2012) model. To determine the accuracy of individual self-risk assessments, this study compared user online entries with program nurse assessments.

Is the web-based lung cancer risk self-assessment tool based on the PLCOm2012 model accurate in predicting lung cancer risk among Albertans aged 50 to 74 years when incorporated into an existing lung cancer screening program?

This retrospective study used administrative data from the Alberta Lung Cancer Screening Program, which was designed to enroll 3,800 participants from September 2022 to September 2024. All self-referrals from the web tool with a risk score ≥ 1.5% were included up to July 2024. Concordance was assessed between web entries and matched nurse assessments and the impact of discordant lung cancer risks estimated.

A total of 384 matched entries were analyzed. The mean age of the participants was 64 ± 6 years, and most were currently smoking (61%). The study revealed high (> 95%) concordance between web entries and nurse assessments; concordance for education, smoking intensity, and smoking duration were slightly lower (90%-92%). Although a discrepancy in at least 1 value was common (32%), this resulted in an eligible participant being re-categorized as ineligible only in 3.7% of cases. Overall, 65% of participants had concordant PLCOm2012 risk scores (within 0.1%). The differences in PLCOm2012 risk between web and nurse entries ranged from - 3% to 2.5%.

This study described the feasibility of implementing a web-based lung cancer risk self-assessment tool based on the PLCOm2012 model and found a high concordance of discrete data points between the web entries and nurse entries. However, at least 1 value was discordant in one-third of the participants, and this occasionally affected risk scores. Confirmation of lung cancer risk by a health care provider remains important prior to screening.